Samina Mustafa
M.Phil. Scholar
The realm of mental healthcare extends far beyond the purview of psychiatrists or psychologists alone, particularly in resource-constrained environments where untreated mental health issues are burgeoning at an alarming pace. The dearth of specialized mental health experts exacerbates the situation, with a mere 1,000 psychiatrists and 3,000 psychologists catering to a population of over 240 million individuals in our country. The resulting scenario renders specialized mental health care exorbitant, inaccessible, and inefficient, a predicament mirrored in numerous low- and middle-income countries (L&MICs).
In the face of acute depressive episodes, the conventional recourse is either the prescription of antidepressant medications or the provision of psychological therapy. A growing body of evidence now underscores the efficacy of psychological treatments over medication in sustaining long-term well-being after an initial episode. However, the accessibility of psychotherapy remains a challenge for the majority, leading to irrational prescriptions of antidepressants, often employed without a comprehensive understanding of their appropriateness.
The scarcity of specialists has prompted mental health researchers to develop evidence-based psychological interventions suitable for non-specialized settings, employing a task-shifting approach. Dr. Shekhar Saxena, formerly associated with the World Health Organisation (WHO), played a pivotal role in curating a mental health gap intervention guide (mhGAP) in 2010, subsequently updated in 2016. Covering a spectrum of mental health issues such as depression, psychosis, epilepsy, and more, the guide signifies a significant milestone in mental healthcare for L&MICs.
A cornerstone of this global initiative is the WHO Thinking Healthy manual, grounded in research conducted in Pakistan. Dr. Atif Rahman, a distinguished psychiatrist and mental health expert, spearheaded this research through the Human Development Research Foundation, shedding light on perinatal depression and its profound impact on maternal and child well-being. The Thinking Healthy Programme (THP), rooted in cognitive-behavioral therapy (CBT), emerged from one of the largest randomized controlled trials conducted in the developing world, demonstrating promising outcomes in mitigating perinatal depression rates among impoverished rural communities.
The success of THP, as adopted by WHO, transcends borders, with implementation in over 30 countries, including China, Vietnam, India, and Peru. Despite its cost-effectiveness and adaptability to community health workers and peer counselors, the challenge lies in scaling it up nationally while preserving its efficacy. Dr. Atif Rahman and his team persist in this effort, exploring innovative uses of technology and extending the program to school mental health initiatives.
It is disheartening that the origins of the WHO Thinking Healthy Programme, rooted in Pakistani research, often go unrecognized. Awareness of this fact is crucial, as it underscores the significant contributions made by Pakistanis to the global discourse on mental health interventions. Those seeking further insights into THP are encouraged to explore the resources mentioned above, including an enlightening article by Vikram Patel and Atif Rahman in the Journal of the American Academy of Arts and Sciences, titled ‘Empowering the (Extra)Ordinary.’
The author, a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University, WHO adviser on UHC, and member of the Pakistan Mental Health Coalition, was inspired to write this article following a mental health meeting where the WHO Thinking Healthy Programme was referenced, prompting a realization that its roots lie in Pakistani research
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